Improving Norway’s Cervical Cancer Screening Guidelines

Abstract image with colorful shapes

CHDS’ Allison Portnoy, Emily Burger, Jane Kim, and Stephen Sy  and colleagues from the University of Oslo collaborated with The Section for Cervical Cancer Screening in Norway to design and analyze screening strategies to improve the effectiveness and efficiency of the Norwegian cervical cancer screening program.

Norway is considering modifying their cervical cancer screening recommendations now that women who have previously received the HPV vaccine (and hence are at a much lower risk of cervical cancer) have reached screening age. The modifications would primarily aim to reduce screening harms caused by unnecessary referrals to colposcopy.  New technology able to identify a positive HPV screen’s specific HPV genotype can be utilized to classify positive tests as high carcinogenic risk, medium risk, and intermediate risk; women can then be managed according to their respective risk level. Higher risk types can be referred directly to colposcopy, while less-risky types can be followed up with another test to see if the HPV infection persists.  The analysis also considered modifying the time between a positive screen and a follow-up re-test, as well as different ages to begin using the classification scheme.

The group at CHDS ran over 30 scenarios (including the current Norwegian cervical cancer screening guidelines) through their HPV and cervical cancer models. They concluded that the current guidelines were not as beneficial and were more costly than some of these newly designed alternatives. With a lower willingness-to-pay threshold, the optimal strategy involved the following: starting the follow-up algorithm at age 35, direct colposcopy for high-risk HPV-positive genotypes, 24-month follow-up for medium-risk, and 60-month follow-up for intermediate-risk. With a higher willingness-to-pay threshold, the same algorithm can begin at age 30 instead of age 35.

Learn more: Read the publication, Cost-Effectiveness of Primary Human Papillomavirus Triage Approaches Among Vaccinated Women in Norway: A Model-Based Analysis
Learn more: Read the publication, Choosing Wisely: A Model-Based Analysis Evaluating the Trade-Offs in Cancer Benefit and Diagnostic Referrals Among Alternative HPV Testing Strategies in Norway
Learn more: Read the publication, Impact and Cost-Effectiveness of Strategies to Accelerate Cervical Cancer Elimination: A Model-Based Analysis
Learn more: Read the publication, Adapting Cervical Cancer Screening for Women Vaccinated Against Human Papillomavirus Infections: The Value of Stratifying Guidelines
Learn more: Read the publication, Cost-Effective Management of Women with Minor Cervical Lesions: Revisiting the Application of HPV DNA Testing

Related news: CHDS at European SMDM 2023
Related news: CHDS at International HPV Meeting